ArticleInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society2023
Validation of a risk-based algorithm to reduce poor operative outcomes after complex surgery for ovarian cancer.
Article in International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed, 8 citations in OpenAlex.
- Surgery in ovarian cancer patients older than 70 years of age and frailty assessment.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Surgical complexity and scope of procedures necessary after neoadjuvant chemotherapy for primary ovarian cancer.Gynecologic oncology · 2025Article
- Bevacizumab in Platinum-Sensitive Recurrent Epithelial Ovarian Cancer: A Risk-Stratified Analysis.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Diagnostic accuracy of tru-cut biopsy and acid cytology from patients operated with suspicious for ovarian cancer*.Revista da Associacao Medica Brasileira (1992) · 2025Article
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9 authors at 4 institutions in 2 countries.
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Abstract
objectiveWe developed an algorithm that identifies patients at high risk of morbidity/mortality after cytoreductive surgery for advanced ovarian cancer. We have previously shown that the Mayo triage algorithm reduces operative mortality internally, followed by validation using an external low complexity national dataset. However, validation in a higher complexity surgical setting is required before widespread acceptance of this approach, and this was the goal of our study.
methodsWe included patients who underwent debulking surgery (including primary or interval debulking surgery) for stage IIIC/IV ovarian cancer between October 2011 and November 2019 (SCORPION trial patients until May 2016 and non-trial patients thereafter) at Fondazione Policlinico A Gemelli, Italy. Using the algorithm, we classified patients as either high-risk or triage-appropriate and compared 30-day grade 3+ complications and 90-day mortality using a χ
resultsA total of 625 patients were included. The mean age was 58.7±11.4 years, 73.6% (n=460) were stage IIIC, and 63.0% (n=394) underwent primary debulking surgery. Surgical complexity was intermediate or high in 82.6% (n=516) of patients (95.7% (n=377) for primary surgery and 60.2% (n=139) for interval surgery), and 20.3% (n=127) were classified as high-risk. When compared with triage-appropriate patients, high-risk patients had (1) a threefold higher rate of 90-day mortality (6.3% vs 2.0%, p=0.02); (2) a higher likelihood of 90-day mortality following a grade 3+ complication (25.9% vs 10.0%, p=0.05); and (3) comparable rates of grade 3+ complications (21.3% vs 16.1%, p=0.17).
conclusionThe evidence-based triage algorithm identifies patients at high risk of morbidity/mortality after cytoreductive surgery. Triage high-risk patients are poor candidates for surgery when complex surgery is required. This algorithm has been validated in heterogeneous settings (internal, national, and international) and degree of surgical complexity. Risk-based decision making should be standard of care when planning surgery for patients with advanced ovarian cancer, whether primary or interval surgery.
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